Peripancreatic lymphoadenopathy and extrahepatic immunological manifestations in chronic hepatitis C

Abstract. The aim of the study was to determine the role of peripancreatic lymph node swelling in systemic immunological alterations during chronic hepatitis C (HC). The prospective study was carried out as a clinical study in a university hospital. Clinical, haematochemical and ultrasonographic findings in 182 patients were studied. Ultrasonography was performed by the same operator and the findings were evaluated blind without the operator knowing the clinical and haematochemical parameters. Hepatitis B virus (HBV) markers, anti-HCV antibodies. LKMl, cryoglobulinaemia, rheumatoid factor and anti-tissue antibodies were determined. Liver biopsy was carried out in 43 of the 182 patients. One or two pathological peripancreatic lymph nodes (PLNs) were present in 30 of the 182 patients and, of the 30, 28 were anti-HC positive. Only one patient in the non-PLN group was positive for anti-HCV, there being statistical significance ( P <0.0001) between the PLN and non-PLN groups. In HCV-positive patients, extrahepatic immunological manifestations were observed (cryoglobulinaemia; positivity to anti-smooth muscle, antinuclear and antimitochondrial antibodies; positivity to rheumatoid factor and LKMl). In five patients the presence of focal lymphocytic aggregates was detected by biopsy, whereas one patient presented typical ocular lesion of Mikulicz's syndrome. Our results may confirm the marked lymphotropism shown by the HC virus and indicate more complex immune system involvement, especially in view of the coexisting signs of immune system involvement related to the presence of intrahepatic cellular aggregates detected in our study. We believe that the peripancreatic adenopathy in chronic HCV hepatitis is an important diagnostic sign and may indicate an involvement of the C virus in the still unexplained extrahepatic immunological disorders.     

儿童慢性轻度哮喘治疗的临床研究

目的　探讨 3～ 8岁儿童慢性轻度哮喘的早期干预治疗方法。方法　将 12 0例 3～ 8岁慢性轻度哮喘患儿随机均分为治疗组 1、2和对照组。治疗组 1:3～ 5岁患儿口服孟鲁司特 (顺尔宁 ) 4 .0mg/d ,5～ 8岁服5 .0mg/d ,疗程 3～ 6个月 ;治疗组 2 :予口服盐酸西替利嗪 2 .5～ 5 .0mg/d ,疗程 3～ 6个月 ;对照组 :口服安慰剂。均于每日睡前服用。结果　与治疗组 2及对照组相比 ,治疗组 1的日间及夜间症状出现率、急性加重发生率、月均 β 受体激动剂使用率、峰值呼气流速 (PEF)变化、嗜酸性粒细胞计数 (EC)下降率的差异有显著性 (P <0 .0 1) ,而住院率、药物不良反应率的差异无显著性 (P >0 .0 5 )。治疗组 2与对照组EC值的差异有显著性 (P <0 .0 1) ,其余指标的差异均无显著性 (P值均 >0 .0 5 )。结论　白三烯受体拮抗剂孟鲁司特单独用于慢性轻型哮喘儿童的早期干预治疗具有疗效好、不良反应小及患儿依从性高的特点     

国产鼻喷鲑鱼降钙素治疗骨质疏松性疼痛的疗效观察

目的观察国产鼻喷鲑鱼降钙素治疗骨质疏松性疼痛的疗效。方法采用随机分组对照设计。选择骨质疏松患者53例,随机分为两组,治疗组(30例)给予鼻喷鲑鱼降钙素,20u/次,1次/天,8周为1个疗程,停药后继续观察3周。对照组(23例)口服钙尔奇D片,1片/次,1次/天,共8周;采用国际惯用分级标准对疼痛予以评估。结果治疗组患者的疼痛明显改善,其总有效率为95%;在停药后缓解疼痛的作用仍可维持4周以上,Ⅲ度骨质疏松患者的治疗效果较Ⅰ度和Ⅱ度患者的效果差;对照组症状未见明显改善。结论用国产鼻喷鲑鱼降钙素治疗骨质疏松性骨痛,可明显缓解患者的疼痛症状。     

Brain-derived neurotrophic factor in cerebrospinal fluid of patients with chronic daily headache: relationship with nerve growth factor and glutamate levels

Little has been done to investigate the biochemical basis of chronic daily headache (CDH). Our group has recently demonstrated an increase in the cerebrospinal fluid (CSF) levels of nerve growth factor (NGF) in CDH patients, supporting the involvement of this growth factor in the abnormal processing of head pain in this pathological condition. Other members of the neurotrophin family, especially brain-derived neurotrophic factor (BDNF), have been hypothesized as being involved in the development of chronic head pain in patients affected by CDH, but so far no data are available on this subject. BDNF, NGF and glutamate levels were determined in the CSF of 25 patients affected by CDH with a previous history of migraine. These levels were compared with those of a group of 20 control subjects, for whom the CSF examination and other instrumental investigations excluded diseases of the central and peripheral nervous systems. Significantly higher levels of BDNF, NGF and glutamate were found in CDH patients compared with control subjects (p<0.0001, p<0.0002 and p<0.001, respectively). A significant positive correlation emerged between CSF values of BDNF and those of NGF (r=0.61, p<0.001) and glutamate (r=0.44, p<0.025) in CDH patients. No significant differences were detected in BDNF, NGF and glutamate levels between CDH patients with analgesic overuse and those without. These results support the involvement of BDNF in CDH through the potentiation of glutamatergic transmission involved in the processing of head pain. The significant correlation between BDNF and NGF levels suggests that NGF-mediated up-regulation of BDNF in central sites involved in long-term sensitization plays a key role in persistent head pain in CDH patients. Correspondence to P. Sarchielli     

Vulvodynia: evolution of classification and management

The aim of this article is to make the reader familiar with the history and current status of vulvodynia. The account is presented as a historical survey, from the seventies to the nineties. It explains how and why the term came to be defined, and how some sub-groups – in particular dysaesthetic vulvodynia and vulval vestibulitis – have been identified and described. Their management is discussed. The importance of distinguishing these conditions from those which are variants of normal is stressed.
It is noted that these sub-groups have much in common, so that a degree of convergence or overlap has come to be recognised. In parallel with this, ideas concerning aetiology and optimal management have been clarified and are explored.
Appreciation of the present state of affairs, and of how it has been arrived at, will help to improve management. It will also facilitate the collection of data, which in turn may lead to further research and understanding of vulvodynia.     

Single visit root canal treatment: incidence of postoperative pain using three different instrumentation techniques

A clinical study was carried out on nonvital maxillary central incisors to evaluate the incidence of postoperative pain following single-visit root canal treatment using three different instrumentation techniques. Ninety teeth from 78 patients whose ages ranged from 14 to 63 years were selected and divided into three groups. Each group (30 teeth) was prepared by a different coronal-to-apical technique using different instrument movement depending upon the technique employed: modified double-flared, crown-downpressureless and balanced force techniques. No difference was observed in the incidence of postoperative pain among the groups.     

Transfer of lumbosacral load to iliac bones and legs Part 1: Biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise

This study deals primarily with the stability of the base of the spine. The sacroiliac joints are vulnerable to shear loading on account of their predominantly flat surfaces. This raises the question of what mechanisms are brought into action to prevent dislocation of the sacroiliac joints when they are loaded by the weight of the upper part of the body and by trunk muscle forces. First a model is introduced to compare load transfer in joints with spherical and with flat joint surfaces. Next we consider a biomechanical model for the equilibrium of the sacrum under load, describing a self-bracing effect that protects the sacroiliac joints against shear according to ‘the sacroiliac joint compression theory’, which has been demonstrated in vitro. The model shows joint stability by the application of bending moments and the configuration of the pelvic arch. The model includes a large number of muscles (e.g. the gluteus maximus and piriformis muscles), ligaments (e.g. the sacrotuberous, sacrospinal, and dorsal and interosseous sacroiliac ligaments) as well as the coarse texture and the ridges and grooves of the joint surfaces.     

Lamotrigine in the treatment of painful diabetic neuropathy

An open trial was conducted to study the potential efficacy of lamotrigine, a novel antiepileptic agent that blocks voltage-sensitive sodium channels and inhibits the release of glutamate, in relieving the pain associated with diabetic neuropathy. Subsequent to a 1 week washout period from previous analgesics, lamotrigine was administered at a dose of 25 mg/day for 1 week. The dose was doubled on a weekly basis up to 400 mg/day over 6 weeks. The McGill pain questionnaire (MPQ), spontaneous pain and a series of mechanical and thermal stimuli-induced pain were measured with the use of 0–100 visual analogue scale (VAS), on seven office visits. Pain level was also recorded by each patient twice daily, 1 week before, during, and 2 weeks after the treatment period with the use of a 0–10 numerical pain scale (NPS). Quantitative mechanical (Von Frey filaments) and thermal testing (QTT), and routine blood tests were performed at the beginning and at the end of the study. Thirteen patients completed the study. Spontaneous pain measured by VAS and NPS gradually dropped from a baseline of 49 ± 8 and 6.8 ± 0.6, to 20 ± 8.6 ( p < 0.001) and 4.3 ± 0.9 ( p < 0.001), respectively, at the end of the treatment period. Similarly, cold allodynia dropped from 38 ± 9.2 to 16 ± 15.3 ( p = 0.01), and the MPQ score from 13.6 ± 0.8 to 11.0 ± 1.5 ( p < 0.01). In contrast, no significant changes were found in the QTT, mechanical pain thresholds and laboratory results. Two patients were withdrawn from the study because of adverse effects. A long-term follow up showed that most patients were still using lamotrigine 6 months after the end of the study. The results of the study suggest that lamotrigine is potentially effective and safe in treating painful diabetic neuropathy.     

Direct evidence for the link between monoaminergic descending pathways and motor activity:: II. A study with microdialysis probes implanted in the ventral horn of the spinal cord

In order to define precisely the relation between descending monoaminergic systems and the motor system, we measured in the ventral horn of spinal cord of adult rats the variations of extracellular concentrations of 5-HT, 5-HIAA, DA and MHPG. Measurements were performed during rest, endurance running on a treadmill, and a post-exercise period, with microdialysis probes implanted permanently for 45 days. We found a slight decrease in both 5-HT and 5-HIAA during locomotion with a more marked decrease during the post-exercise period compared to the mean of rest values. In contrast, the concentration of DA and MHPG increased slightly during the exercise and decreased thereafter. These results, when compared with those of a previous study, which measured monoamines in the spinal cord white matter [C. Gerin, D. Bécquet, A. Privat, Direct evidence for the link between monoaminergic descending pathways and motor activity: I. A study with microdialysis probes implanted in the ventral funiculus of the spinal cord, Brain Res. 704 (1995) 191–201], highlight the complex regulation of the release of monoamines that occurs in the ventral horn.     

Muscular performance after a 3 month progressive physical exercise program and 9 month follow-up in subjects with low back pain. A controlled study

The purpose of this study was to assess, in subjects with low back pain, the changes and their permanence in muscular performance after a 3 month progressive physical exercise program. Ninety subjects with chronic low back pain participated in the study. The study design was controlled and it was carried out in three groups: intensive training, home exercise, and control group. Isometric and dynamic muscle strength of the trunk and lower limb were measured, at the beginning of the study and after the 3 months exercise program, and then during each of the follow-up sessions. The Oswestry Index and back pain intensity were also determined. Both exercise groups received benefit from the progressive exercise program. Their muscular performance improved and their back pain intensity decreased significantly. Among the home exercise group, the Oswestry Index also changed positively. The results demonstrate that the home exercise program could be as effective as the intensive training program in increasing muscle strength, as well as decreasing back pain and functional disability among low back pain patients with mild functional limitations.